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The “high-risk” patient

A "high risk" patient with legal addictions to junk food and tobacco.
She would be an excellent candidate for a trial of a drug to "treat" the symptoms, like "cholesterol", of a self-destructive lifestyle. Such people are beloved of drug dealers and trialist doctors on their payrolls because they are "high risk" and have high rates of "events" (i.e. artery bypass, heart attack and death) allowing investigators to publish papers faster and drug dealers to sell more drugs. Thus, all testing of drugs for lifestyle diseases necessitates conflict of interest. To insist that such people change their habits first would reduce "events", most of which are non-fatal, and prolong trials for so long that the high-paid "trialists" would die of old age before enough "events" had been registered to be statistcally significant. So NO trial of drugs for diseases of lifestyle has ever made a serious attempt to change lifestyles before trying drugs. All such trials were and are, therefore, UNETHICAL. Reports of the results of such trials should be retracted by the journals involved and the results should be ignored by all doctors. All such ongoing trials should be halted immediately.

Personally, I refuse to take any advice from anyone who receives even one cent from a drug dealer.

I completely agree with Dr Kishore’s statement:

“Increasingly, ‘Western’ high-fat diets, tobacco use and urbanization have
helped make heart disease a bigger killer than ‘The Big Three’—HIV/AIDS,
tuberculosis and malaria—combined.”

Indeed, high risk individuals have high risk lifestyles.

But the FIRST thing to do is change the diet and eliminate tobacco BEFORE labeling statins essential drugs. To do otherwise will reduce any incentive to improve lifestyle and make the obesity and diabetes pandemic even worse.

Do you think that the “developing” world is going to be happy with generic simvastatin? Not likely. They are going to start demanding patented Crestor and Vytorin, just like the rich Americans.

Weill Cornell Medical College Students Help Change Global Health Policy

NEW YORK (May 21, 2007) – In a move to improve global public health, Weill
Cornell Medical College students have helped place a lifesaving heart
disease drug onto the World Health Organization’s (WHO) list of essential
medicines. This list is a guideline for developing countries to choose which
high-priority drugs should be supplied to their citizens inexpensively.

Students from Weill Cornell’s chapter of Universities Allied for Essential
Medicines (UAEM) answered the charge of Dr. David Skorton, President of
Cornell University, and Dr. Antonio M. Gotto Jr., dean of Weill Cornell
Medical College, to “seek new strategies for Cornell to advance public
health” across the globe.

“I am extremely proud that the students at Weill Cornell Medical College
have had such an admirable influence on global health policy,” says Dr.
Skorton, who is also a professor of internal medicine and pediatrics. “Such
actions by our students show the promise of their future leadership.”

“Adding this medicine to the list of essential medicines represents an
exceptional achievement by our students,” says Dr. Gotto, an internationally
renowned expert in heart disease prevention, who served as the senior
advisor for the project. “Because of the students’ success, over 150
national governments that work with WHO will be encouraged to recognize
heart disease as a serious health concern deserving of great medical
attention.”

UAEM comprises a national group of students whose goal is to determine how
universities can help ensure that biomedical products, including medicines,
are made more accessible in poor countries and further the amount of
research conducted on neglected diseases affecting the poor.

“For years, it was thought that heart disease was a concern of affluent
countries. But, today, nearly 80 percent of all deaths due to heart disease
occur in the developing world,” says Sandeep Kishore, an MD-PhD student at
Weill Cornell Medical College who helped spearhead the initiative with UAEM.
“Increasingly, ‘Western’ high-fat diets, tobacco use and urbanization have
helped make heart disease a bigger killer than ‘The Big Three’—HIV/AIDS,
tuberculosis and malaria—combined.”

Kishore and Ben Herbstman, UAEM members, petitioned WHO that simvastatin
(Zocor)—originally manufactured by Merck—be added to the list. Simvastatin
was selected based on its worldwide availability, cost-effectiveness and the
interest of generic firms in producing it. Such statin medicines have been
shown to lower low-density lipoprotein cholesterol (LDL) levels, commonly
known as “bad cholesterol,” by 25-30 percent in individuals at high-risk for
heart disease.

Last month, the students from UAEM — with the assistance of medical
librarians from Weill Cornell’s Samuel J. Wood Library & C.V. Starr
Biomedical Information Center — were successful in their efforts to get a
generic version of Zocor included on the list of essential medicines. Now,
the United Nations and other philanthropic foundations can donate large
numbers of the statin drug to the national pharmaceutical inventories of
developing countries.

Furthermore, generic versions of the medicine will be sold at a fraction of
their original price tag. The drug will cost as little as $40 per year per
person—10 cents a day—down from nearly $1,200 a couple of years ago.

The announcement comes on the heels of Cornell University’s new Africa
Initiative, a university-wide movement to promote sub-Saharan African
development and health.
The Weill Cornell chapter of UAEM has hosted an ongoing series of global
health events. On June 15, the former CEO of Merck, Inc., Dr. Roy Vagelos,
will present a lecture titled “Corporations Can and Should Do Social Good”
in a seminar exploring new academic-pharmaceutical alliances to increase
access to medicines worldwide.
Weill Cornell Medical College

Weill Cornell Medical College—located in New York City—is committed to
excellence in research, teaching, patient care and the advancement of the
art and science of medicine. Weill Cornell, which is a principal academic
affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum
that integrates the teaching of basic and clinical sciences, problem-based
learning, office-based preceptorships, and primary care and doctoring
courses. Physicians and scientists of Weill Cornell Medical College are
engaged in cutting-edge research in such areas as stem cells, genetics and
gene therapy, geriatrics, neuroscience, structural biology, cardiovascular
medicine, AIDS, obesity, cancer and psychiatry—and continue to delve ever
deeper into the molecular basis of disease in an effort to unlock the
mysteries behind the human body and the malfunctions that result in serious
medical disorders. Weill Cornell Medical College is the birthplace of many
medical advances—from the development of the Pap test for cervical cancer to
the synthesis of penicillin, the first successful embryo-biopsy pregnancy
and birth in the U.S., and most recently, the world’s first clinical trial
for gene therapy for Parkinson’s disease. Weill Cornell’s Physician
Organization includes 650 clinical faculty, who provide the highest quality
of care to their patients. For more information, visit http://www.med.cornell.edu.

Cubans don’t measure their blood cholesterol obsessively as recommended by “guideline” committees in the US, Canada and Britain, on which sit doctors paid in various ways by statin manufacturers. Statins are almost impossible to get in Cuba but Cubans live longer than Americans who spend $US billions on statins like Lipitor. Cubans eat mostly a unrefined plant-based diet, have few cars and have less obesity. And Cuba spends only 4% of what the US does on “health” care per capita. Just think of what we could do with more than a trillion dollars PER YEAR. That would fund a few manned trips to Mars every year not not to mention funding free university education, cleansing the environment, obliteratiing infectious disease and poverty…

———————————————–

U.S. healthcare costs more than Cuba’s and may not have an edge in helping people live longer, but Cubans often lack prescription drugs and over-the-counter remedies.

BY JOHN DORSCHNER

jdorschner@MiamiHerald.com

The average Cuban lives slightly longer than the average American, but the American’s healthcare costs $5,711 a year while the Cuban’s costs $251.

Those are the figures of the World Health Organization. Some experts question the accuracy of the Cuban numbers, but no one doubts the underlying revelation: There is little relationship between the cost of your healthcare and how long you’ll live.

”Medical care is responsible for only a small portion of the variation in life expectancy,” says Gerard Anderson, a Johns Hopkins professor specializing in health policy. “Behavioral factors such as diet and exercise are much more important. The U.S., which spends much more than any other industrialized country on healthcare, is getting little value for much of the spending.”

These factors have moved to the forefront of the American political discussion as leaders in both major parties work toward solving what almost everyone agrees is a ”healthcare crisis,” with soaring costs threatening to increase the numbers of the uninsured, which already include 46 million Americans.

In such a discussion, Cuba serves as the starkest possible contrast, a completely government-controlled system in which ailing leader Fidel Castro benefits from the best possible care, including consultations with a Madrid surgeon, while many Cubans struggle to get basic treatment.

Here are the numbers: The average American has a life expectancy of 77.8 years, as of 2006. The average Cuban lives 78.3 years. Even if the Cuban figure is inflated, no one disputes the statistics from European countries, where people tend to live a year or two longer than in the United States — at about half the healthcare costs per capita.

At its highest level, most people agree, the United States has top-quality care. The country offers the latest magnetic resonance imaging, robotic-arm surgeries and drugs to deal with cholesterol, acid reflux and arthritis pain.

Americans want the biotech drug to target tumor cells, but many don’t get basic preventive screening tests. That’s particularly true for the uninsured, who often avoid treatment until their condition sends them to the emergency room.

Cuba offers universal healthcare and has twice as many doctors per capita as the United States. The Cuban government did not respond to The Miami Herald’s request for comment via telephone or e-mail, but its publications have boasted that the country is one of the world’s leaders in healthcare. Ann C. Seror, a professor at Laval University in Quebec, Canada, says Cuba has “achieved a remarkable level of healthcare quality of life for its citizenry.”

But six Cuban doctors The Miami Herald interviewed — two dissidents still on the island, four now in Miami — say many prescription drugs and even over-the-counter remedies are nearly impossible to get, and patients sometimes have long waits in clinics unless they pay bribes.

One irony is that poverty has forced Cubans into a healthier lifestyle. Juan A. Asensio, a University of Miami trauma surgeon and a Cuban American who is certainly no friend of the Castro regime, put it this way: “No McDonald’s, and Cubans walk everywhere or ride bikes because they can’t afford cars.”

About one in 10 Cubans are obese, according to the Pan American Health Organization. In the United States, one in three are obese, ”increasing risks of high blood pressure, type 2 diabetes, stroke, heart disease and osteoarthritis,” according to the Agency for Healthcare Research and Quality.

Still, the aging American, no matter his weight, can lay claim to a more comfortable life, with access to everything from Advil to Pepto-Bismol and Viagra — products virtually nonexistent in Cuba.

As Nestor Viamonte, a physician who left Cuba in 2003, puts it: “There’s a difference between a 75-year-old with quality of life and a 75-year-old without quality of life.”